The Impact of Expedited Discharge on 30-Day Readmission After Lung Resection: A National Study.

Abstract

Expedited discharge (within 24 hours) after lung resection has received scrutiny because of concerns for higher readmissions and paradoxically increased costs. The present study examined the impact of expedited discharge on hospitalization costs and unplanned readmissions by using a nationally representative sample. In addition, the study sought to determine interhospital practice variation. Adults undergoing elective lobar or sublobar resection were identified using the 2016 to 2018 Nationwide Readmissions Database, and patients with a postoperative duration of hospitalization longer than 5 days or those who experienced any perioperative complication were excluded. Patients were classified as Expedited if their postoperative hospitalization duration was 0 or 1 day and otherwise were classified as Routine. Inverse probability of treatment weighing was used to adjust for intergroup differences. Hospitals were ranked according to risk-adjusted early discharge rates. Multivariable regression models were developed to assess the association of expedited discharge on nonelective 30-day readmissions, as well as associated mortality and costs. Of an estimated 84,152 patients, 13,834 (16.4%) comprised the Expedited group. Compared with the Routine group, the Expedited patients were younger and less likely to have chronic obstructive pulmonary disease and to have undergone open procedures. After adjustment, early discharge was associated with lower incremental costs (β coefficient: -$3.6K; 95% confidence interval, -4.4 to -2.8), as well as similar readmissions (odds ratio, 0.89; 95% confidence interval, 0.70 to 1.13) and related-mortality. Nearly one-half (48.1%) of all hospitals performed zero early discharges. Expedited discharge after lung resection is a feasible management strategy and is associated with decreased costs and similar readmission risk compared with the norm. Select individuals should be strongly considered for expedited discharge after lung resection.